Provider Network Support Specialist

Memorial Hermann Health System

About The Position

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Job Summary Serves established network providers, focusing on payor issue resolution. Responsible for directly contracting and supporting network providers and their office staff with the ultimate goal of maximizing in-network knowledge, participation, and satisfaction for providers. Activities include: facilitating credentialing issues, resolving payor issues, adding and maintaining providers to payor rosters, driving reports, maintaining provider database, running network participation rosters, facilitating workflow processes in special network initiatives (i.e., membership bonus processes). Additionally, serves as a resource to internal/external network customers.

Requirements

With degree one (1) year of relevant experience
Without degree four (4) years of relevant experience
Knowledge of managed care and risk contracting, claims resolution; and changes in the healthcare environment.
Strong communication skills for provider audiences
Strong interpersonal skills to effectively interact and build strong relationships with stakeholders
Excellent organizational and prioritization skills; ability to multi-task
Strong critical thinking and analytical skills to identify customer needs and develop action plans
Working knowledge of MS Office Products including: Excel, Word, and PowerPoint.

Nice To Haves

Bachelor’s degree is preferred
In lieu of a bachelor’s degree, four (4) years of industry experience, in provider relations, claims operations, insurance or managed care environments preferred
Knowledge of Accountable Care Organizations (ACO), Clinical Integration (CI), and Patient Centered Medical Home (PCMH) environments is preferred
Data entry and customer service experience is preferred
Knowledge of MS Access is a plus

Responsibilities

Answers provider inquires related to credentialing and resolving payor issues.
Facilitates the process of onboarding providers to new payor contracts, including educating the provider on contract obligations, obtaining required documents, and coordinating membership approval through the required parties.
Maintains accurate provider records as necessary for payors, including setup of demographics/specialty information, applicable networks, payor contracts, and effective dates; ensures data integrity and processes member updates as appropriate.
Ensures completion of requests for new or updates to provider records within five (5) business days of receipt of complete and accurate loading documents.
Collaborates with team members in the preparation of departmental daily and monthly operational and production reports, including roster maintenance, as required.
Communicates timeline expectations to payors & providers and follow-up to assure compliance with timelines.
Is accessible to internal and external customers to listen to concerns and issues, communicate our understanding, give the them an expectation of how and when we will respond, and follow-up until the issue is resolved.
Researches and resolves internal & external customer issues in coordination with other areas, as appropriate.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences.
Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.